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Cilostazol Hints at Promise for Stroke Prevention

Stroke survivors see lower -- but not statistically significant -- risk of recurrence compared to aspirin

WEDNESDAY, May 7 (HealthDay News) -- Cilostazol, a selective inhibitor of phosphodiesterase 3, was not associated with a significantly different effect on the rate of stroke recurrence as compared to aspirin, according to research published online May 5 in The Lancet Neurology.

Yining Huang, M.D., of the Peking University First Hospital in Beijing, China, and colleagues analyzed data from 720 survivors of recent ischemic stroke who were randomized to receive cilostazol or aspirin for 12 to 18 months. The primary endpoint was recurrence of stroke (ischemic, hemorrhagic or subarachnoid hemorrhage).

At the end of the study, the cilostazol group had a 38 percent lower relative risk of a primary endpoint compared with the aspirin group, though this finding didn't reach statistical significance. The incidence of severe cerebral bleeds was significantly higher in the aspirin group.

"The implications of these results for clinicians are that they offer hope for a safer antiplatelet drug that is at least as effective as aspirin for use in patients with ischemic stroke. The implications of these results for researchers are the need to explore the external validity of these pilot study results in a phase III randomized trial that compares cilostazol with aspirin (or with the new gold standard of antiplatelet therapy, pending the results of the PRoFESS trial) in a large number of high-risk patients with recent ischemic stroke from a wide range of nations and ethnic groups," writes Graeme J. Hankey, M.D., of the Royal Perth Hospital in Australia, in an accompanying commentary.

Huang and a co-author disclosed financial relationships with Otsuka, which provided funding for the study. Hankey disclosed financial relationships with several pharmaceutical companies.

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